Mira’s story: trust in your health-care provider can go a long way in transforming diabetes care

Mira, a tenacious and energetic 67-year-old woman from Alamedin district near Bishkek in Kyrgyzstan, has been living with diabetes since 1985. Her story is one of resilience and community, and conviction that living a healthy life is possible. 

As an active member of a local support group, she is a passionate advocate for the effectiveness of these groups in helping people manage their condition. 

“We live with diabetes, and I know it can be managed,” she says. “But I think that many people are still afraid of the condition, and that’s what I think we need to concentrate more on.” 

Getting rid of the fear of diabetes, Mira says, is about trusting your doctor and taking charge of your own health. Her commitment to a healthy lifestyle and regular medical check-ups mirrors her advocacy for others grappling with diabetes. 

“Adopt a healthy lifestyle, go see your doctor, get tested, and don’t be afraid.” 

Trust, Mira says, is key. 

“I am in constant contact with my endocrinologist, I call her all the time,” she says, emphasizing the bond they share. “We talk, we sit, she explains everything to me.” 

This trust is a cornerstone of her diabetes management – a partnership founded on mutual respect and understanding.

For example, once her blood sugar level dropped, and the doctor advised her to modify the insulin dose. 

“So, if the doctor tells me I need to do something, I do it,”  she recalls.

In the wake of a pandemic that has eroded people’s confidence in institutions, including health systems, this trust in health-care providers is essential. WHO/Europe’s upcoming Tallinn Health Systems Conference spotlights the critical issues of trust and transformation and examines the effect these have on health care. 

The conference will focus on the growing sentiment that health services will not deliver for people when they are needed, and on why health and care workers feel increasingly undervalued by the system. This is echoed in Mira’s testimony, and that of the doctors and nurses caring for diabetes patients in Kyrgyzstan.  

Change is not always easy, especially when managing health conditions 

In the WHO European Region alone, at least 64 million adults over the age of 18, and around 300 000 children and adolescents, live with diabetes. By 2045, the International Diabetes Federation estimates that almost 1 in 10 people in the European Region could have diabetes as populations age and obesity rates climb.

Diabetes is generally under-detected, under-treated and under-controlled. Many complications, such as foot problems because of blood supply issues, are avoidable – as are the associated health and social care costs. Simple measures such as frequent foot care can reduce the risk of amputation.

Kyrgyzstan, where an estimated 256 400 people live with the condition, is grappling with the same challenges: only 60% of people with diabetes are diagnosed. 

In 2022, the Ministry of Health, supported by WHO/Europe and the World Diabetes Foundation, began the implementation of a new project in Kyrgyzstan. Essentially, the project is about improving the quality of care for diabetes through, for example, changing who diagnoses the condition and supports the diabetes patients in its management. 

“Patients used to be managed by endocrinologists only, and their diabetes care was never entrusted to family doctors and nurses,” explains Dr Guldana Jolchieva, endocrinologist at the National Centre for Endocrinology in Bishkek. “This led to a series of problems, one of them being, for example, long waiting times since endocrinologists simply couldn’t cope with so many patients.”

By enabling patients to go directly to primary care centres and be seen by their family doctors or nurses, the project is transforming the way diabetes is being managed in the country. Patients have been trusted to take an active role in the design of these care pathways – and in evaluating how well they work.

“First of all, patients now have more confidence in their family doctors and nurses; and second, they don’t need to travel long distances, so they can get the care they need at their local primary care centre,” explains Dr Nataliya Dobrynina, the lead endocrinologist at the National Centre for Endocrinology. 

Trust as the enabler of change 

The transformation has seen enhanced and more widespread training of primary care doctors and nurses – in detecting diabetes cases, managing the condition and preventing complications, especially with patients’ eyes, feet and cardiovascular systems. 

Alita, a feldsher nurse in Alamedin district, explains how the trainings have revolutionized the way she cares for the diabetes patients in her area.

“Before, we used to refer patients to a polyclinic far from here to get their blood sugar levels checked, and for some of the older patients this was impractical,” she says. “Now we do our own blood-sugar testing, run our own laboratory tests, and offer our own counselling, talking to them about their diet, weight loss and lifestyle in general.”

This, Alita says, has also changed the way she feels about her work. She is happy that her newly acquired skills are helping patients in her district better manage their conditions. 

“I think they trust me now, and come here more often,” she says. 

A new vision for health systems that put people first 

The transformation in Kyrgyzstan’s diabetes care goes beyond procedural changes. It is a testament to trust – the evolving relationship between patients and health-care providers, the policy-makers and patient associations, and growing confidence in the evolving landscape of diabetes care.

This shift is at the heart of a new health systems vision that WHO/Europe and its partners will discuss at the Tallinn Conference on 12–13 December 2023.  

Alita’s dedication and the commitment of doctors like Nataliya and Guldana amplify this narrative – a tale of transformation where trust builds bridges between patients and health-care providers. When patients like Mira feel they can trust their health-care providers and the system in which they work, and are supported in self-management, they will take charge of their own health.